Death raises questions about Urgences Santé

Aaron Derfel, Gazette Health Reporter08.08.2012

A Beaconsfield physician, who performed CPR on a 65-year-old friend, Arnaud Ratel (pictured) last week while Ratel suffered a heart attack, says a 911 operator hung up the phone on her son when he called to report the emergency. Ratel died. Urgences Santé has launched an internel investigation into whether one of its medical call-takers hung up on a 15-year-old boy who phoned 911 to report the heart attack.

MONTREAL - Urgences Santé has launched an internal investigation to determine whether one of its medical call-takers hung up on a 15-year-old boy who phoned 911 to report a man was suffering from a heart attack.

The 65-year-old man died on the scene, and his death has raised questions about whether Urgences Santé responded to the emergency properly.

The incident occurred on July 27 after a dinner party in Beaconsfield in honour of a couple’s 60th wedding anniversary. One of the guests, Arnaud Ratel, was walking toward his car outside when he collapsed. Two other dinner guests, who are a married couple and both doctors, raced outside to give Ratel cardio-pulmonary resuscitation.

As one of the doctors, Simone Guillon, was massaging Ratel’s heart, her 15-year-son, Vincent, called 911 on his iPhone just before 11 p.m. The boy’s phone logs the call at 10:47 p.m., while Urgences Santé reports the call was made at 10:48 p.m.

A 911 dispatcher transferred the call immediately to an Urgences Santé medical call-taker, and this is where the controversy arises.

Guillon told The Gazette that at first, the Urgences Santé call-taker ordered her son to tell his parents to stop administering CPR. When the boy replied his parents wouldn’t do so, the Urgences Santé call-taker hung up, Guillon said.

“The operator asked my son whether (Ratel) had vomited, and my son said: ‘Look, my mother is a doctor and my father is a surgeon and they’re giving CPR.’ The operator told him to tell us to stop the heart massage, and he said to me: ‘Mum, they’re telling me to tell you to stop the massage.’

“My husband said: ‘We’re not going to stop, we need an ambulance. We need an ambulance fast.’

“And the guy from Urgences Santé said to my son: ‘If you don’t co-operate, I’ll hang up’, and he then hung up on him.”

Vincent was so distraught he threw his iPhone to the ground. Another guest then phoned 911, and this time was asked by another Urgences Santé call-taker whether he would now co-operate, Guillon said.

“I could just imagine a 10-year-old or a 12-year-old calling Urgences Santé, watching something catastrophic happening and the person on the other line refuses to send help because the child is not co-operating,” added Guillon, a family physician with 30 years’ experience.

A first responder from the Beaconsfield fire department did arrive on the scene, followed by an ambulance as well as an Urgences Santé advanced-life support unit that can administer certain drugs.

Urgences Santé has refused a request by The Gazette to listen to the 911 tapes, citing “patient confidentiality.” The Gazette first began making inquiries with Urgences Santé on Friday, and the ambulance service waited until Tuesday to respond — and only after speaking first with Guillon.

However, he added “we have to do our internal investigation to determine whether (the medical call-taker) acted inappropriately.”

“We’re examining that in our investigation — did he hang up? Did he finish his protocol?”

Nevertheless, Urgences Santé records do show the organization responded quickly and deployed sufficient resources, he said.

The records show Vincent, the 15-year-old boy, initially reported Ratel was suffering from a convulsion. Under Urgences Santé guidelines, there is no need to administer CPR during a convulsion because the victim was “likely breathing and had a pulse,” and that’s why the boy was advised to tell his parents to stop CPR, Sasson explained.

However, within 44 seconds of that call, the Urgences Santé responder could overhear that Ratel was not breathing. More than a half minute after that realization, or within 76 seconds of the call being placed, the Urgences Santé responder ordered vehicles to the scene.

Within four minutes and 44 seconds of that call, a first responder from the fire department arrived with a defibrillator. Sasson notes the average Urgences Santé time to arrival for such emergencies is five to six minutes, “so this response time was above average.”

Despite the breakdown in communication, Guillon praised both the Beaconsfield Fire Department and Urgences Santé’s professionalism on the scene. (She initially was under the impression it took 15 minutes for the teams to arrive, but she attributes that to the pressures of trying to save Ratel.)

“We’re glad this is being investigated because it’s not correct to hang up,” Guillon said.

Sasson also apologized to The Gazette on behalf of Urgences Santé “for the lack of priority (in responding to the newspaper), if you can call it that.”

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